Monday, September 04, 2006

We Dilate and Stent for Bread

When we started to bring angioplasty back to Malaysia there was a cartoon of a boy wearing tattered clothes standing at a street corner, carrying a placard that says "I dilate for bread". This reminds us constantly, we do not to do angioplasty for financial gain.

There is no denying that angioplasty is a lucrative business. The professional fee is about three thousand ringgit per angioplasty. I am told of one interventionist, who charges by the number of vessels done. I will not be quick to judge the right or wrong, especially when we have no national data, of PCI volumes, cost and charges.

What I do know is that a recent article in the New York Times, entitled "High PCI rates in Ohio town raises questions". The article mentions that one center in Ohio has 3 times the national average rate of angioplasty in USA. This surely will raise question as to whether the PCI was done for the professional's financial gain. In USA, the lay press will highlight these things which will bring other relevant authorities in to investigate. Many bodies will begin checking, including the director of the Medical Center.

In Malaysia, I am sure this same phenomena is happening and there are few relevant bodies to provide any checks and balance. Our National Heart Association will certainly have problems dealing with this issue. It's entirely possible that some council members may not have clean hands or we may like to believe that "it takes a thief to catch a thief".

Perhaps we should be glad that the bad guys in the first category are trained. We now see "peripheral interventionist" (and I use the term here charitably) organizing Live Demos. Perhaps its for publicity, to get lay attention (advertise) and also try to establish their own credentialsm which clearly do not come from formal training. Worse yet, these people leave no trail and keep on registry. There is totally no record of the disasters they have wreaked on helpless patients.

How do you stop this unhealthy practice? In this regard, from the money-greed angle, the new PHCFS Act and Regulations, tries to address this issue, with a stated fee schedule. Yet, without a good statistical department, we will never know what is the national average standard. There is so much work for us to do, but we are too engross with live Demo courses. Perhaps the end of year ICF 2006 will allow us to see what each of us is doing? This forum, as I understand it, will try to influence practice patterns of PCI in Malaysia, but it surely has no punitive power. We hope to influence by persuasion. It's like sending a kitty cat to do the job of a tiger. The cat can look cute and hope you feed it but a tiger demands and has the teeth to get it.

We still have a longway to go. Sometimes when I hear talk about EBM (evidence base medicine) I shiver. Do we know what it means? Do we believe in it? enough to practice it? Well time will tell and in the meantime we dilate for bread.

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